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Systematic pelvic lymphadenectomy improves surgical staging, but not survival in patients with early-stage endometrial cancer, study shows

Friday, December 26 2008 | Comments

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What's This? The addition of pelvic systematic lymphadenectomy to standard hysterectomy with bilateral salpingo-oophorectomy in patients with early-stage endometrial cancer results in a statistically significant improvement of surgical staging with no improvement of disease-free or overall survival, researchers recently reported.

The authors randomized 514 eligible patients with preoperative FIGO (International Federation of Gynecology and Obstetrics) stage I endometrial carcinoma to undergo pelvic systematic lymphadenectomy (n=264) or no lymphadenectomy (n=250) in addition to standard hysterectomy with bilateral salpingo-oophorectomy.

In the pelvic systematic lymphadenectomy arm, a median of 30 total lymph nodes were removed (interquartile range, 22-42); none were removed in the no-lymphadenectomy arm (P<.001). The proportion of patients in the lymphadenectomy arm with lymph node metastases was 13.3%, which was significantly greater than the 3.2% in the no-lymphadenectomy arm (difference, 10.1%; 95% CI, 5.3%-14.9%; P<.001); therefore, systematic pelvic lymphadenectomy significantly improved surgical staging, the investigators noted.

Early and late postoperative complications occurred more frequently in patients who had received pelvic systematic lymphadenectomy (n=81) than in patients who had not received lymphadenectomy (n=34; P=.001). Most of the difference in morbidity was due to lymphocysts and lymphedema occurring in 35 patients in the lymphadenectomy arm compared with only 4 patients in the no-lymphadenectomy arm.

Endometrial cancer recurred in 67 patients (12.9% in the lymphadenectomy arm and 13.2% in the no-lymphadenectomy arm) after a median follow-up of 49 months. During that period there were 53 deaths.

In an intent-to-treat analysis, the lymphadenectomy arm and the no-lymphadenectomy arm had similar 5-year disease-free survival rates (81.0% and 81.7%, respectively) and overall survival rates (85.9% and 90.0%, respectively). The unadjusted risks for relapse (hazard ratio [HR] in lymphadenctomy arm vs no-lymphadenectomy arm, 1.10; 95% CI, 0.70-1.71; P=.68) and death (HR, 1.20; 95% CI, 0.70-2.07; P=.50) were similar in both study arms. Multivariate analysis that controlled for age, tumor grade, myometrial invasion, and stage yielded similar risks.

"Pelvic systematic lymphadenectomy did not change the natural history of [endometrial cancer] as can be inferred from the pattern of disease recurrence, which was similar between the 2 groups," the study's authors indicated. "However, pelvic lymphadenectomy did allow for an accurate prognosis on the basis of a pathological lymph node assessment." (Panici PB, et al. J Natl Cancer Inst 2008;100:1707-1716.)

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